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  • Ipc Questionnaire

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    Adnan Amin
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    The document is a questionnaire that asks individuals to indicate where they are in changing a health behavior. It then asks follow up questions depending on where the individual marked themselves on a scale from "not prepared to change" to "already changed". If marked on the left, it asks what signals would indicate it's time to think about changing and when they plan to change. If in the middle, it asks why and what could move them further right. If on the right, it asks what helped them take that step and what could help the change work better.

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    The document is a questionnaire that asks individuals to indicate where they are in changing a health behavior. It then asks follow up questions depending on where the individual marked themselves on a scale from "not prepared to change" to "already changed". If marked on the left, it asks what signals would indicate it's time to think about changing and when they plan to change. If in the middle, it asks why and what could move them further right. If on the right, it asks what helped them take that step and what could help the change work better.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as docx, pdf, or txt
    52 views1 page

    Ipc Questionnaire

    Uploaded by

    Adnan Amin
    The document is a questionnaire that asks individuals to indicate where they are in changing a health behavior. It then asks follow up questions depending on where the individual marked themselves on a scale from "not prepared to change" to "already changed". If marked on the left, it asks what signals would indicate it's time to think about changing and when they plan to change. If in the middle, it asks why and what could move them further right. If on the right, it asks what helped them take that step and what could help the change work better.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as docx, pdf, or txt
    of 1

    Questionnaire Name:_________________

    Age: __________________
    Profession: _____________

    Changing Behavior for Your Health


    On the line below, mark where you are now on this line that measures change in behavior. Are you not
    prepared to change, already changed or someplace in the middle?
    Not prepared to change Changing Already changed

    Answer the questions below that apply to you.


     1. If your mark is on the left side of the line:
    a) How will you know when it's time to think about changing?
    _________________________________________________________________________
    b) what signals will tell you to start thinking about changing?
     _________________________________________________________________________

     c) When are you planning to change your behavior? (mention a specific date)

     _________________________________________________________________________
    2. If your mark is somewhere in the middle:
    a) Why did you put your mark there and not to the extremes?
     _________________________________________________________________________
    b) what might make you put your mark a little further to the right?
     _________________________________________________________________________
    c) What are the barriers to changing?
     _________________________________________________________________________

     3. If your mark is on the right side of the line:

    a) What made you decide on that particular step?


     _________________________________________________________________________
    b) what has worked in taking this step?
    _________________________________________________________________________
    c) what could help it work even better?
     ___________________________________________________________________

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